Managing Opioid Use Disorder Through Collaborative Care

Opioid use disorder (OUD) can be effectively managed in primary care through collaborative care models (CCM), according to a new cluster randomized clinical trial published in JAMA Psychiatry.¹ The study, known as the Collaborating to Heal Addiction and Mental Health in Primary Care (CHAMP) trial, found that integrating OUD treatment into CCM significantly reduced opioid use but did not yield additional improvements in mental health–related quality of life compared with CCM focused on mental health symptoms alone. The findings represent a significant step forward in the integration of substance use care within primary care clinics.

The evidence points to CCM as an effective, scalable model to address persistent gaps in OUD management within primary care. | Image credit: Antonio Rodriguez - stock.adobe.com

Opioid use disorder remains a significant public health concern in the United States, affecting an estimated 2% of the population, with 74,972 opioid overdose deaths recorded between March 2024 and March 2025.² Medications for OUD (MOUD) such as buprenorphine and naltrexone are effective in reducing overdose and mortality, yet "fewer than a quarter of people with OUD receive MOUD."³ Primary care physicians already prescribe a majority of MOUD, but more than half of patients discontinue treatment within 6 months.⁴ The CCM framework, which has established effectiveness in depression, anxiety, PTSD, and bipolar disorder, was evaluated here for its impact on OUD and co-occurring mental health symptoms.^5-7

The CHAMP trial recruited 254 patients across 24 primary care clinics from 15 health systems.¹ Participants had both OUD and mental health symptoms but were not receiving specialty psychiatric or addiction care. Most participants were White (83.2%), followed by 6.5% Black and 8.7% who identified as Hispanic or Latino. Socioeconomic vulnerabilities were prevalent, with 44.5% of the population living below the poverty threshold, 25.3% unemployed, and 11.2% lacking stable housing. Nearly half (47.6%) reported a history of overdose, and one-third reported being moderately to extremely bothered by cravings. At baseline, 81.1% were taking MOUD, most commonly buprenorphine-naloxone.

Both groups received CCM for mental health, including care managers, psychiatric consultants, and structured measurement-based care for mental health symptoms. Management of OUD in the control group was treated as "usual care," involving referrals and PCP prescribing without dedicated CM or psychiatric consultant support for OUD. In the intervention arm, care managers also supported MOUD adherence, monitored withdrawal and craving symptoms, and provided behavioral activation tailored for co-occurring OUD and mental health conditions.

At 6 months, opioid use declined in both groups but fell more sharply in the intervention arm. Patients in the intervention group reported a reduction in opioid use from 3.66 days at baseline to 0.72 days, compared with 5.73 to 3.92 days in the control group. Relapse rates also favored the intervention arm. Among participants not using opioids at baseline, 15.2% in the control group relapsed by 6 months compared with 3.2% in the intervention group.

Additionally, 91.7% of patients in the intervention arm and 78.3% in the control arm were taking MOUD at the 6-month follow-up. Mediation analyses confirmed that MOUD consistency predicted reduced opioid use (P < .001), although between-group differences in consistency were not statistically significant.

Mental health-related quality of life improved modestly in both groups, from a baseline Veterans RAND 12 Mental Health Component Summary score of 34.18 to 38.90 in the control group and from 34.81 to 39.09 in the intervention group. Similarly, secondary outcomes, including depression, anxiety, PTSD, pain, and access to care, showed only small gains without meaningful differences between groups. The researchers hypothesize, "It could be that our relatively short 6-month follow-up period was insufficient to observe the benefit of discontinuing opioid use on mental health functioning and that patients needed a longer time in treatment before seeing gains."

"Any nonmedical use of opioids is potentially lethal, especially for those with occasional use and lower tolerance, and for those obtaining opioids from nonmedical sources with varying levels of toxicity," investigators noted, highlighting that use approached zero in the intervention group at 6 months, and the reduction of even occasional use represents a meaningful clinical victory. They add, "Overall, these findings indicate that OUD can be successfully managed with MOUD in primary care with CCM, especially CCM for OUD and MHS."

Despite the positive findings, the study acknowledges several limitations and challenges to widespread implementation. The participating clinics were self-selected, and many had prior CCM training, which may limit the generalizability of these results to all primary care settings. Recruitment of patients also proved challenging, with 254 patients enrolled over 32 months from 42 clinics, suggesting that treating large numbers of patients with OUD may be difficult in CCM programs. This could pose challenges to acquiring and sustaining the necessary clinical skills for OUD management.

The authors suggest that "One option is to use a hub-and-spoke telepsychiatry CCM approach for OUD, which has been found to be effective for other psychiatric disorders." Nonetheless, the evidence points to CCM as an effective, scalable model to address persistent gaps in OUD management within primary care, with significant reductions in opioid use and maintenance of MOUD adherence.

References

1. Fortney JC, Ratzliff AD, Blanchard BE, et al. Collaborative Care for Opioid Use Disorder in Primary Care: A Hybrid Type 2 Cluster Randomized Clinical Trial. JAMA Psychiatry. 2025:e252126. doi: 10.1001/jamapsychiatry.2025.2126

2. National Center for Health Statistics. Provisional drug overdose death counts. Accessed August 26, 2025. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

3. NIH - National Institute of Drug Abuse. Medications for Opioid Use Disorder. March 2025. Accessed August 26, 2025. https://nida.nih.gov/research-topics/medications-opioid-use-disorder

4. Olfson M, Zhang V, Schoenbaum M, King M. Buprenorphine treatment by primary care providers, psychiatrists, addiction specialists, and others. Health Aff (Millwood). 2020;39(6):984-992. doi:10.1377/hlthaff.2019.01622

5. Unützer J, Katon W, Callahan CM, et al; IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836-2845. doi:10.1001/jama.288.22.2836

6. Roy-Byrne P, Craske MG, Sullivan G, et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA. 2010;303(19):1921-1928. doi:10.1001/jama.2010.608

7. Fortney JC, Bauer AM, Cerimele JM, et al. Comparison of teleintegrated care and telereferral care for treating complex psychiatric disorders in primary care: a pragmatic randomized comparative effectiveness trial. JAMA Psychiatry. 2021;78(11):1189-1199. doi:10.1001/jamapsychiatry.2021.2318